Management of paediatric arrhythmias in Europe: authors' reply
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AntonioHernandez-Madrid, JianChen, TatjanaPotpara, LaurentPison, TorbenBjerregaard Larsen, Heidi L.Estner, DerickTodd, MariaGrazia Bongiorni, CarinaBlomström-Lundqvist
on behalf of the Scientific Initiative Committee, European Heart Rhythm Association
We appreciate the letter by Juha-Matti Happonen et al.1 addressing our recently published EP wire on, ‘How are arrhythmias managed in the paediatric population in Europe? Results of the European Heart Rhythm Survey’.2
Europe encompasses a very large but diverse EP community, including physicians with various backgrounds and specialities coming from many countries and centres, with inherent differences regarding clinical practice, implementation of guidelines and their legal implication, access to modern therapies, and health economic systems.
Ideally, patient registries can capture such differences in patient management and thereby improve quality of care. Registries are, however, often associated with significant efforts and cost for the healthcare community, and seldom gives a quick insight into the clinical practice or their adoption to guidelines. As the Scientific Initiative Committee of the European Heart Rhythm Association (EHRA), we have continued to publish the so-called ‘EP wires’. These are surveys, consisting of short questionnaires with 15–25 questions, accessible via the Internet for centres which voluntarily has declared their interest to participate in EHRA's, Electrophysiology (EP) Network. The aim with these EP Wire surveys is to provide a quick insight into current clinical practice and adoption to guidelines in the EP community in Europe. Well aware of and recognising the limitations with these surveys, it is our believe that by spreading the results and demonstrating regional and/or geographical differences regarding use or access to modern therapies, it may hopefully improve the situations for many of our patients and colleagues. Such surveys may also recognize unmet needs for education.
The aim of this specific EP Wire survey was to provide insight into current practice regarding the management of paediatric arrhythmias in Europe. The survey was based on a questionnaire sent via the Internet to the EHRA, EP Network Centres. We did not intend to analyse practice among paediatric EP centres exclusively. Furthermore, surveys can only reflect the past and what is asked for in a limited number of centres. We do, however, welcome the participation of paediatric EP centres and the EP network can be reached on our website.
Our results are based on the non-paediatric EP community and in the results we stated: ‘Catheter ablation of paediatric arrhythmias was exclusively performed by paediatric electrophysiologists in only 2.56% of the centres, while EP teams were multidisciplinary in 15.36% of hospitals or the same teams performed ablations in both children and adult patients (82.05%)’. This means that most centres do perform paediatric ablation, even if they may not be the ‘centres only specialized in paediatric arrhythmias’. We believe it is quite common in Europe.
Given the limitations with both surveys and registries, the former being based on physician's perception and the latter most often being on a voluntary basis, we still believe that many of these EP wires and registries contribute to an increased awareness of differences in healthcare and educational needs.
Correct that none of the authors are paediatric cardiologist, and electrophysiologists only but many with wide experience in paediatric catheter ablation procedures and related publications.3 The volume of ablation procedures performed is the key for a high quality. We believe that our survey supports the need for a continued collaboration with the paediatric EP community and we welcome a corresponding survey, or a Registry, involving ALL centres performing paediatric ablations.
European Heart Rhythm Association; Association for European Paediatric and Congenital Cardiology. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. Europace 2013;15:1337–82.